BACKGROUND: Ankle arthritis, like hip and knee arthritis, has a substantial impact on patient function. Understanding the functional limitations of ankle arthritis may help to stratify treatment strategies.METHODS: We measured the preoperative demographic characteristics, physical function, and self-assessed function of patients with end-stage ankle arthritis and identified correlations among these metrics. Participants wore a StepWatch 3 Activity Monitor for two weeks and completed the Musculoskeletal Function Assessment and Short Form-36 surveys. Gait kinematics and kinetics were also measured as participants walked at a self-selected pace.RESULTS: Musculoskeletal Function Assessment and Short Form-36 scores revealed reduced perceived function for patients with end-stage ankle arthritis compared with healthy controls. These patients also took fewer total steps per day, took fewer high-intensity steps, and chose to walk at a slower walking speed. Gait analysis revealed reduced ankle motion, peak ankle plantar flexor moment, peak ankle power absorbed, and peak ankle power generated for the affected limb compared with the unaffected limb. High-intensity step count was also correlated with both survey scores, walking speed, step length, peak ankle plantar flexor moment, and peak ankle power generated. Walking speed, step length, and ankle motion were correlated with peak ankle plantar flexor moment and power generated.CONCLUSIONS: Generally, patients with end-stage ankle arthritis have reduced physical and perceived function compared with healthy individuals. Additionally, high-intensity step count was a better indicator of physical and perceived function compared with total steps per day for this population.CLINICAL RELEVANCE: Functional impairments related to ankle arthritis are substantial. In addition, significant associations among perceived function, sustained high-intensity step count, and certain gait variables can further define the utility of these outcome measurements in this patient population.